Provider Demographics
NPI:1174536403
Name:PAWLOWSKI, THERESA (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:
Last Name:PAWLOWSKI
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 DELAWARE AVE
Mailing Address - Street 2:SUITE 204, LINWOOD COMMUNITY SERVICES
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202
Mailing Address - Country:US
Mailing Address - Phone:716-882-3151
Mailing Address - Fax:716-886-4002
Practice Address - Street 1:625 DELAWARE AVE
Practice Address - Street 2:SUITE 204, LINWOOD COMMUNITY SERVICES
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202
Practice Address - Country:US
Practice Address - Phone:716-882-3151
Practice Address - Fax:716-886-4002
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064942-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY071895-1OtherLCSW
NY064942-1OtherLMSW